Paper: “We take the decision according to the protocol”: Humanitarian healthcare workers’ moral experiences of palliative care related decision-making in Cox’s Bazar, Bangladesh

Paper details

Paper authors *Rachel Yantzi, Md Hadiuzzaman, Pradip Kumar Sen Gupta, Amin Lamrous, Kathryn Richardson, John Pringle, Lisa Schwartz, Puspita Hossain, David Kizito, Sakib Burza
In panel on Palliative care in humanitarian action: Moving from awareness to integration
Paper presenter(s) will be presenting In-Person / Online


The Médecins Sans Frontières (MSF) Goyalmara Hospital in Cox’s Bazar, Bangladesh is a pediatric and neonatal referral centre serving the Rohingya camps and host community. Efforts are underway to integrate palliative care due to high mortality and medical complexity of patients. The purpose of this study was to understand the moral experiences of MSF staff who provide palliative care to inform program planning and implementation.

This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of protocols and other documents. A coding scheme was developed, and data coded using NVivo 11.

A key finding of this study was the important yet contested role of clinical guidelines and policies in palliative care related decision-making. Certain staff saw clinical guidelines as a valuable resource that supported a consistent approach to care over time, particularly during international staff transitions, while other staff felt that guidelines were inappropriately or rigidly applied. There is a need to create space for open discussion of values and priorities of staff, patients, and families to alleviate moral distress among staff and ensure that palliative care approaches are tailored to local contexts and patient/family preferences.